Congenital unilateral agenesis of the ovary and fallopian tube is a rare condition that has been previously described in the literature. While this condition is benign, studies have proposed it could be associated with infertility. The purpose of this report is first to highlight a rare incidental finding of unilateral ovarian and fallopian tube agenesis. Secondly, we aim to discuss the various imaging modalities used for the detection of uterine, ovarian, and fallopian tube defects and their shortcomings. Our case describes a 37-year-old G4P0030 woman with an obstetric history of spontaneous abortion and ectopic pregnancy, presenting at 38 weeks gestational age with polyhydramnios. The patient received routine obstetric care with no abnormalities being reported on routine ultrasonography. Elective cesarean section was performed at which time the incidental condition discovery of unilateral agenesis of the right ovary and fallopian tube was made. This case is unique since the incidental diagnosis of unilateral right ovarian and right fallopian tube agenesis occurred during cesarean delivery instead of through imaging. It is important for patient counseling to understand the typical workup and deficiencies in pelvic imaging concerning congenital anomalies
INTRODUCTION: Abnormal placentation, including placenta accreta, have been occurring at a higher incidence than before due to the increase in cesarean sections. The gold-standard treatment if uncontrolled bleeding occurs is peripartum hysterectomy, depriving woman of future fertility. The purpose of this case was to apply a conservative management by using a helium plasma device to fulgurate the placenta accreta at the uterine site. METHODS: Patient informed consent was obtained for submission of a case report. Cesarean delivery with low-vertical incision and manual extraction of the placenta was performed. The uterus was exteriorized and the helium plasma radio frequency (RF) device (J-Plasma system) was used to fulgurate the retained placental tissue, confirming hemostasis with a radius of 3 cm from the site. Hemabate was given to the site to maintain uterine contraction. RESULTS: The helium plasma device provided adequate hemostasis to the 12.76 cc of retained placenta accreta at 40% power 4 L/min gas flow, reducing lateral and depth damage of normal endometrial tissue. Quantitative blood loss was 560 cc. Obstetric hemorrhage and peripartum hysterectomy were avoided, allowing for future fertility. CONCLUSION: The helium plasma RF device provided a high-precision and efficient operative time in conservatively managing placenta accreta. This adds a safer alternative form of managing abnormal placentation and avoiding radical treatment. More research and trials should be done on larger placenta accreta and on other morbidly adherent placentas. It will be able to allow woman of high-risk to maintain their ability of reproducing in the future since a peripartum hysterectomy could be avoided.
The incidence of abnormal placentation has escalated due to the increase in cesarean sections. Adherent placentas are associated with significant maternal morbidity and mortality and often result in cesarean hysterectomy due to life-threatening hemorrhage. The purpose of these case reports is to describe conservative management of placenta accreta by utilizing a helium plasma device to fulgurate the placental bed. Placenta accreta is associated with a 60% mortality rate and 7% morbidity rate. Conservative treatment for uterine preservation include embolization, placenta left in-situ, uterine balloon tamponade, and methotrexate. Complications of these options include hemorrhage, endometritis, and morbidly adherent placentas (MAP) recurrence in subsequent pregnancies. The helium plasma device utilizes radiofrequency (RF) to ionize helium into a plasma beam capable of coagulating and fulgurating tissue with high precision and minimal thermal spread. This instrument is Food and Drug Administration (FDA) approved for surgical coagulation and fulguration, but has not been evaluated in the treatment of placenta accreta at the time of a cesarean section. The helium plasma device was used to fulgurate the placenta accreta at 40% power 4 L/min gas flow for 30 seconds, providing adequate hemostasis to the 12.76 cc of retained placental bed. Estimated blood loss was 560 cc. The patient remained hemodynamically stable and had no complications at follow up. The device provided efficient management of placenta accreta. This approach offers a safer alternative management of abnormal placentation and avoiding a cesarean hysterectomy. This novel surgical technique allows women with morbidly adherent placentas to maintain reproductive capability.
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